Bone Health for Runners: Part 2
Runner performing a return-to-run progression on a track
If a bone stress injury has sidelined you, the hardest part is often knowing how to get back to running without landing right back where you started. This is Part 2 of our bone health series — here is how to reintroduce impact and running so you can stay healthy and injury-free.
If you are unfamiliar with the nature of bone stress injuries (BSIs), more commonly known as stress fractures, review Part 1, where we discussed how to identify symptoms, recognize risk factors, and seek treatment. If a stress fracture has been identified with X-ray or magnetic resonance imaging (MRI), the steps below outline suggested next steps for reintroducing running.
Healing timeframes
Bone stress injuries occur on a spectrum, so the timeframe for bone healing can range based on the location and grade of the injury. "Low risk" areas tend to heal faster, while "high risk" areas have less direct blood supply and take more force through them with running, so they take longer to heal.
| Risk category | Example locations | Typical healing time |
|---|---|---|
| Low risk | 2nd–4th metatarsals, tibia, fibula | 4–8 weeks |
| High risk | Femoral neck, 5th metatarsal, navicular | 8–12+ weeks |
Returning to impact
It is important to prepare your bones, muscles, and tendons for running or other high-impact sports after taking time off with an injury. When you can walk without pain, you can start adding in hops and a variety of plyometrics. Here are some ideas:
- Double-leg hops
- Single-leg hops
- Bounds, skipping, and carioca
- Box jumps
Running considerations
When you can perform brisk walks and plyometrics without pain, it is time to initiate a run-walk program. Start with run-walk intervals — for example, run 2 minutes and walk 4 minutes for a duration of 20 minutes total. Rest the following day and keep an eye out for symptoms in the healing area.
Your return-to-run program should progress slowly, with a gradual increase of no more than 10% in mileage each week. Once you can run pain-free for a continuous 30 minutes, start adding more distance, intervals, or hill training to your routine.
Key takeaway
Key rule: increase your weekly mileage by no more than 10% as you build back up.
Come see us at Kauno for a performance assessment and a return-to-run plan built around your injury.
Common questions
How long does a bone stress injury take to heal?
It depends on the location and grade of the injury. Low-risk areas such as the 2nd–4th metatarsals, tibia, or fibula may take 4–8 weeks, while high-risk areas such as the femoral neck, 5th metatarsal, or navicular may take up to 8–12+ weeks.
When can I start plyometrics after a stress fracture?
When you can walk without pain, you can start adding in hops and a variety of plyometrics such as double-leg hops, single-leg hops, bounds, skipping, carioca, and box jumps.
What does a run-walk program look like?
Once you can perform brisk walks and plyometrics without pain, start with run-walk intervals — for example, run 2 minutes and walk 4 minutes for a duration of 20 minutes total. Rest the following day and watch for symptoms in the healing area.
How quickly can I increase my mileage?
Increase your weekly mileage by no more than 10% each week. Once you can run pain-free for a continuous 30 minutes, start adding more distance, intervals, or hill training.
